Provider Demographics
NPI:1801778287
Name:CASSELL, JACK (MA)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:CASSELL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 UNIVERSITY BLVD APT 102
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-1143
Mailing Address - Country:US
Mailing Address - Phone:407-453-2676
Mailing Address - Fax:
Practice Address - Street 1:700 35TH AVE
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-1330
Practice Address - Country:US
Practice Address - Phone:205-758-3867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist